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Placebo – Definition, Effect and Use in Medicine

A placebo is a sham preparation without any pharmacologically active ingredient, used in medicine for research and therapeutic purposes.

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Things worth knowing about "Placebo"

A placebo is a sham preparation without any pharmacologically active ingredient, used in medicine for research and therapeutic purposes.

What Is a Placebo?

A placebo (Latin: placebo = I shall please) is a preparation, treatment, or intervention that contains no pharmacologically active substance and has no specific therapeutic mechanism of action. Despite this, a placebo can produce measurable positive effects on a person's health. This phenomenon is known as the placebo effect and is a well-recognized concept in modern medicine.

Forms of Placebos

Placebos can take many different forms, including:

Inert substances: Tablets or capsules made from sugar, starch, or saline without any active ingredient
Sham injections: Injections of saline solution instead of a real medication
Sham surgery: Surgical procedures in which no actual therapeutic intervention is performed
Active placebos: Substances with minor side effects that mimic the experience of a real treatment without possessing its actual mechanism of action

The Placebo Effect

The placebo effect refers to the positive change in a patient's health that results solely from their expectations, the therapeutic relationship, or the treatment context. It is neurobiologically verifiable and is associated with the release of endogenous substances such as endorphins, dopamine, and other neurotransmitters.

Key factors that influence the placebo effect include:

The expectations and beliefs of the patient
Trust in the treating clinician
The appearance and presentation of the treatment (e.g., color or size of a pill)
Therapeutic communication and the overall treatment environment

Use in Clinical Research

Placebos are essential in clinical research. In randomized, placebo-controlled double-blind trials, the efficacy of new medications or therapies is evaluated by comparing a treatment group receiving the real medication with a control group receiving a placebo. Neither the participants nor the researchers know who receives which treatment. This design is considered the gold standard for demonstrating the effectiveness of medical interventions.

Ethical Considerations

The use of placebos in clinical practice raises ethical questions. Deliberately deceiving patients by administering a placebo without their knowledge is ethically and legally problematic in many countries. However, research has shown that open-label placebos -- in which patients are aware they are receiving a placebo -- can still produce positive health outcomes.

The Nocebo Effect

The counterpart to the placebo effect is the nocebo effect: negative expectations can trigger real symptoms or side effects, even when no pharmacologically active substance has been administered. This effect is equally supported by clinical and neurobiological evidence and plays an important role in doctor-patient communication.

References

Finniss DG, Kaptchuk TJ, Miller F, Benedetti F. Biological, clinical, and ethical advances of placebo effects. The Lancet. 2010;375(9715):686-695.
Benedetti F. Placebo Effects: Understanding the Mechanisms in Health and Disease. 2nd edition. Oxford University Press, 2014.
World Health Organization (WHO). Handbook for Good Clinical Research Practice (GCP). WHO Press, Geneva, 2005.

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